Archive for the ‘Seniors’ Category

A Medicare Experiment With a Grim Prognosis

Congress should stop this venture in bad medicine and flawed economics.

By

JEFFREY L. VACIRCA Dr. Vacirca is CEO and chief of clinical research at NSHOA Cancer Center

May 22, 2016 4:50 p.m. ET

Federal bureaucrats announced earlier this year that they plan to upend the way Medicare Part B pays for drugs. The goal? To save money by getting doctors to alter their treatment choices. That’s bad medicine, flawed economics and destructive public policy—and Congress should pass legislation to stop this ill-conceived experiment.

Medicare plays a crucial role in the lives of more than 55 million Americans. It is the only way some seniors can get access to the drugs that keep them alive. The new policy from the Centers for Medicare and Medicaid Services will jeopardize this access by inserting the government between doctors and patients in an unprecedented way.

ENLARGE

PHOTO:GETTY IMAGES

The idea is to use financial incentives to push doctors to make “value-based care” decisions and prescribe cheaper treatments. Unfortunately, modern-day medicine isn’t as black and white as the administration seems to think. Take cancer care, my specialty. There are very few instances when the substitution of a less expensive cancer drug is appropriate or safe for patients. After all, there is a reason the newer, more advanced drugs—such as those that helped former PresidentJimmy Carterput his cancer into remission—are considered groundbreaking.

An Obamacare Report Card

The grades are bad so far—and likely to get worse

Christopher J. Conover

February 17, 2014, Vol. 19, No. 22

Perhaps the most unpleasant aspect of my otherwise quite enjoyable job as a college professor has been the requirement to assign grades to students. Given that we’re now about halfway through implementation of the Affordable Care Act—which even President Obama is happy to call “Obamacare”—it seems appropriate to assign midterm grades. These are not intended as a forecast of the final grade; moreover, implementation of Obamacare is the responsibility of many thousands of individuals, not just one. Nevertheless, as President Truman’s legendary Oval Office desk sign reminds us, “The buck stops here” when it comes to presidential leadership. So whether President Obama likes it or not, the public and historians are likely to base their assessment of his performance on how well his “signature piece of domestic legislation” is implemented.

First Grading Standard:

Promises vs. Performance

Both as a candidate and as president, Barack Obama has made at least 80 promises related to health care. For purposes of grading, I have focused on the 8 most consequential.

Promise #1: Universal Coverage. Candidate Obama promised on June 23, 2007: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American.” The latest CBO projections last May show that as of the end of 2013, Obamacare will have reduced the number of nonelderly uninsured by less than 4 percent. This figure excludes 11 million unauthorized immigrants (51 percent of whom are uninsured). Even when Obamacare is fully implemented in 2017, it will cover only 92 percent of the nonelderly population who are not unauthorized immigrants (nearly everyone age 65 and above is already covered by Medicare), and 84.7 percent of that group already had coverage in March 2009, a full year before Obamacare was signed into law. Even if we concede that other countries relying on an individual mandate have failed to drive their uninsured rates below 1 percent (Switzerland) or 1.5 percent (Netherlands), Obamacare will close only 53 percent of the gap that existed when President Obama was sworn into office. Grade: F.

And these figures do not include the hundreds of billions of dollars in new revenue that will have to be collected by states to pay for their share of Obamacare-induced growth in Medicaid. Nor do they include the impact of “taxation by regulation”—i.e., the tens of billions of dollars in higher premiums that young Americans are being forced to pay under Obamacare’s modified community rating rules in order to subsidize predominantly higher-income people who happen to be older. In short, President Obama’s promise at best was 65 percent true and more likely 50 percent or less true. Grade: F. (more…)

The end of government

Something strange is happening in Washington. We are slowly dismantling the federal government, even as its spending is growing larger. The paradox is that governmental competence is being systematically degraded while the government’s size, as measured by its budget, is increasing. We are spending more and getting less, and — unless present trends are reversed — this will continue for years. It threatens the end of government as we know it.

The cause is no mystery. An aging population and higher health spending automatically increase budget outlays, which induce the president and Congress to curb spending on almost everything else, from defense to food stamps. Over the next decade, all the government’s projected program growth stems from Social Security and health care, including the Affordable Care Act. By 2024, everything else will represent only 7.4 percent of national income (gross domestic product), the lowest sharesince at least 1940, says Douglas Elmendorf, head of the Congressional Budget Office.

This is the central budget story, and it’s largely missed — or ignored — by political leaders, the media, political scientists and the public. The welfare state is taking over government. It’s strangling government’s ability to respond to other national problems and priorities, because the constituencies for welfare benefits, led by Social Security’s 57 million, are more numerous and powerful than their competitors for federal support. Politicians of both parties are loath to challenge these large, expectant and generally sympathetic groups.

The United States, of course, is not the only advanced society grappling with aging, but it is extreme in its stubborn denial of the obvious. The Pew Research Center recently polled people in 21 countries about whether aging is a problem. The United States ranked 19th in its unconcern, ahead of only Indonesia and Egypt, whose populations are young. Only 26 percent of Americans thought aging was a problem. The share was 87 percent in Japan, 55 percent in Germany and 45 percent in France. (more…)

CAROLINA JOURNAL

Before Obamacare, before individual mandates, before exchanges, there was Medicaid. Started in 1965 under President Johnson as part of his War on Poverty, Medicaid extended health insurance coverage to low-income Americans.

Today, Medicaid is the largest publicly funded insurance program in the country. It serves low-income families, the elderly, and disabled. One In five Americans is on Medicaid, more than one-third of the births in the United States are covered by Medicaid, and one-fourth of U.S. children get health care through Medicaid.

Medicaid covers one in nine North Carolinians — 1.6 million of us — and 51 percent of births are covered by Medicaid, the sixth-highest rate in the nation.

Medicaid is funded jointly by the state and federal governments. North Carolina’s share of the program is about $3 billion, while total Medicaid spending in N.C. is closer to $14 billion.

Medicaid spending has grown 90 percent over the last decade and is the fastest-growing part of our state budget, with spending rising by 15 percent in 2011-12; 16.8 percent in
2012-13; and a projected 17.2 percent in 2014-15.

North Carolina’s Medicaid costs are the highest in the South and among the highest in the nation. We have more people enrolled and spend more per patient than neighboring states. Twenty-five percent of the state’s primary care physicians aren’t accepting new Medicaid patients, limiting access, reducing health outcomes for patients, and driving up costs.

Uncontrolled expenses result in consistent budget overruns. Just this year, legislators faced a $400 million shortfall. Since Medicaid is a federal entitlement program, it has to be funded before anything else. Medicaid is the biggest driver of state budget decisions, crowding out other priorities. (more…)

Thanks to Laura Gutman for sharing her letter to the editor to the Herald Sun newspaper of Durham, North Carolina. Nancy

Letters to the editor

Oct. 07, 2013

Shabby treatment of veterans

Soldiers who were 17 at the end of World War II (1945) would now be 85, and would be the youngest veterans of that war. Other survivors are now older, often sick, and with a short life expectancy. Veterans have been traveling to D.C. as part of Honor Flights, a program that enables WW2 veterans to have an expense-paid trip to the World War II memorial that they themselves made possible. The memorial is outdoors and stunningly beautiful.

National parks were closed for the 10/1 shutdown. The House Republicans, who are honoring campaign commitments to voters to delay and defund Obamacare, had passed a bill funding national parks, which the Senate refused. Expecting Honor Flights from their districts, Congressman Palazzo and others requested repeatedly, including to the President, that the WW2 Memorial be made available,. Requests were refused, and the entrance blocked.

The House has passed over five bills to fund specific components of the government including NIH cancer programs for children. The House has passed three bills fully to fund all aspects of the government with the exception of Obamacare, also all refused. The Democrat Senate is preferring to inflict maximal pain on our citizens, including elderly veterans of the Greatest Generation, rather than allow the government to function.

The Senate is trying to protect an unpopular bill so dysfunctional that the sign-up site has been withdrawn. It is using shabby treatment of veterans as a tool. I urge readers to express support for our veterans despite Senate manipulations.

NEWBURYPORT — Pat Vaillancourt went on a trip last week that was intended to showcase some of America’s greatest treasures.

Instead, the Salisbury resident said she and others on her tour bus witnessed an ugly spectacle that made her embarrassed, angry and heartbroken for her country.

Vaillancourt was one of thousands of people who found themselves in a national park as the federal government shutdown went into effect on Oct. 1. For many hours her tour group, which included senior citizen visitors from Japan, Australia, Canada and the United States, were locked in a Yellowstone National Park hotel under armed guard.

The tourists were treated harshly by armed park employees, she said, so much so that some of the foreign tourists with limited English skills thought they were under arrest.

When finally allowed to leave, the bus was not allowed to halt at all along the 2.5-hour trip out of the park, not even to stop at private bathrooms that were open along the route.

“We’ve become a country of fear, guns and control,” said Vaillancourt, who grew up in Lawrence. “It was like they brought out the armed forces. Nobody was saying, ‘we’re sorry,’ it was all like — ” as she clenched her fist and banged it against her forearm.

Vaillancourt took part in a nine-day tour of western parks and sites along with about four dozen senior citizen tourists. One of the highlights of the tour was to be Yellowstone, where they arrived just as the shutdown went into effect.

Rangers systematically sent visitors out of the park, though some groups that had hotel reservations — such as Vaillancourt’s — were allowed to stay for two days. Those two days started out on a sour note, she said.

The bus stopped along a road when a large herd of bison passed nearby, and seniors filed out to take photos. Almost immediately, an armed ranger came by and ordered them to get back in, saying they couldn’t “recreate.” The tour guide, who had paid a $300 fee the day before to bring the group into the park, argued that the seniors weren’t “recreating,” just taking photos.

“She responded and said, ‘Sir, you are recreating,’ and her tone became very aggressive,” Vaillancourt said.

The seniors quickly filed back onboard and the bus went to the Old Faithful Inn, the park’s premier lodge located adjacent to the park’s most famous site, Old Faithful geyser. That was as close as they could get to the famous site — barricades were erected around Old Faithful, and the seniors were locked inside the hotel, where armed rangers stayed at the door. (more…)

Bureaucracy Lives!

How many experts does it take to advise a dying patient?

Wesley J. Smith

August 26, 2013, Vol. 18, No. 47

Back when the mess that is Obamacare was working its way through the legislative sausage factory, warnings about “death panels” almost derailed the entire enterprise. There were two, somewhat related, areas of concern: (1) that Obamacare’s many cost/benefit bureaucratic boards would lead to explicit health care rationing; and (2) that doctors paid to “counsel” elderly and dying patients about end-of-life treatment would actually pressure them to refuse expensive treatments. Owing to the lack of popular trust, the end-of-life counseling provision was dropped to grease the way for Obamacare’s final passage.

Now, the proposal is back in both the House and Senate, with bipartisan support. The Care Planning Act of 2013 is the most far-reaching of the bills. Supported by the AARP and sponsored by Senators Mark Warner (D-Va.) and Johnny Isakson (R-Ga.), the bill ostensibly aims to compensate medical providers who accept Medicare and Medicaid for participating in end-of-life treatment discussions with patients. But that’s just the tip of the proverbial iceberg.

No one is against doctors discussing end-of-life treatment options with patients. That’s part of good medical practice. But once the federal government sets the pay, it will make the rules. It won’t be enough for doctors to talk to their patients about tube feeding, cardiopulmonary resuscitation, and the like. If they want to be reimbursed, doctors will have to structure the conversations in the way the government instructs.

Ever wonder why the health care bureaucracy is becoming so byzantine and sclerotic? This bill—meant to encourage conversations—is 46 pages long. It would create a Care Planning Advisory Board, an “expert” panel of 15 members, three appointed by the president and the remainder by the four partisan leaders of the House and Senate (three apiece). Imagine the patronage opportunities! (more…)

Hospitals Prescribe Big Data to Track Doctors at Work

Marnie Baker, a pediatrician at California’s MemorialCare Health System, has an easy manner and ready smile. Now, though, her job is to be the bearer of a serious and, for some of her colleagues, unwelcome message.

She’s the voice of a program that digitally tracks their performance, informs them when they don’t measure up—and cajoles them to improve.

MemorialCare is part of a movement by hospitals around the U.S. to change how doctors practice by monitoring their progress toward goals, such as giving recommended mammograms. It isn’t always an easy sell. At one clinic earlier this year, physicians grilled Dr. Baker, who is director of performance improvement at a MemorialCare-affiliated physician group.

Cardiologist Venkat Warren said he worried that “some bean-counter will decide what performance is.” He wondered whether doctors would be pushed to avoid older and sicker patients who might drag down their numbers.

“If it isn’t cost-cutting, what is it?” Dr. Warren asked.

“It’s providing better value,” Dr. Baker responded.

Encounters like these are one result of the changes sweeping American health care. Technology is making it easier to monitor doctors’ work as patients’ details are compiled electronically instead of on paper charts. Software makers are selling new tools to crunch the data. Software called Crimson offered by the Advisory Board Co. ABCO-1.54%now includes information on more than a half-million doctors, up from fewer than 50,000 in 2009.

At the same time, more physicians are going to work for hospital systems, which are under pressure to hit quality goals and cut costs. Many are striking deals with insurers that pull them away from traditional “fee-for-service” reimbursement, which pays for medical procedures individually.

Insurers—which themselves increasingly track physician results—are moving toward providing a set payment for the overall care of a patient. This system means that doctors who provide costlier-than-average care could break the budget.

The federal health law is speeding these trends. Under the law, hospital payments and penalties from the federal Medicare program will be linked to their performance on quality gauges, particularly rehospitalizations, which are costly. The law also created a new Medicare initiative for “accountable care organizations,” providers that get extra rewards for efficiency and quality performance.

To succeed under the new health-care economics, hospital executives say, they must lean on doctors, who make nearly all the key decisions on what treatments, tests and drugs patients get. “The last frontier is the physicians,” says Thomas Heleotis, vice president of clinical effectiveness at Monmouth Medical Center, part of New Jersey’s seven-hospital Barnabas Health system. (more…)

Klein: Obamacare’s empress strikes again

Senior Editorial Writer

The Washington Examiner

Popular in Opinion

According to the Washington Post, Health and Human Services Secretary Kathleen Sebelius “has made multiple phone calls to health industry executives, community organizations and church groups and asked that they contribute whatever they can to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law.”

In 2010, shortly after President Obama’s health care legislation was signed into law, I dubbed Health and Human Services Secretary Kathleen Sebelius the “Empress of Obamacare” for the vast new powers she inherited. Reading through the text of the law, I counted more than 2,500 references to the secretary of HHS, of which more than 700 referred to instances in which she “shall” do something and more than 200 cases in which she “may” take regulatory action.

Back then, it was scary enough that any individual would have so many arbitrary powers — from determining what type of insurance every American must purchase to deciding which insurers could sell policies on new government-run exchanges at what price. But in the intervening three years, it’s become even more alarming, because Sebelius has demonstrated a continued pattern of intimidation and abuse of her office.

With a nation digesting news that the IRS targeted conservative groups for special scrutiny and that the Department of Justice obtained phone records of Associated Press journalists, the past week has brought plenty of reminders about the nature of government power.

In the midst of these stories, the Washington Post reported that Sebelius “has made multiple phone calls to health industry executives, community organizations and church groups and asked that they contribute whatever they can to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law.” (more…)

Euthanasia for Obama­care

Jeffrey H. Anderson

October 8, 2012, Vol. 18, No. 04

EXCERPT FROM THIS ARTICLE: Obama-care is making it illegal for anyone in America (with the narrow exception of houses of worship) to freely sell or buy an insurance plan that fails to offer free birth control and sterilization. But this ban is nowhere to be found in the 2,700 pages of the law itself. Rather, it came as a decree from HHS Secretary Kathleen Sebelius, exercising her newfound power. If Obama-care isn’t repealed, examples of such rule by fiat will proliferate.

At a rally in Ohio last week, Mitt Romney said, “Obama-care is really Exhibit No. 1 of the president’s political philosophy, and that is that government knows better than people how to run your lives.” The GOP nominee added, “I don’t believe in a bigger and bigger government. . . . I believe in free people pursuing their dreams. I believe in freedom.”

This is a welcome and winning pitch from Romney. It puts the focus on Obama’s centerpiece legislation, which he spearheaded and signed into law against the clear will of the American people. In so doing, it highlights Obama’s big-government liberalism. And it sets up the key contrasts in this race—decentralized decision-making versus centralized power, prosperity versus profligacy, liberty versus coercion.

James Madison argued in Federalist 51 that our Constitution provides a “double security” to “the rights of the people.” One half of that security is the separation of powers among the three branches of government. The other half is federalism, the separation of powers between the federal government and the states. Madison argued that both of these checks on the concentration of power were essential to securing our rights. (more…)